Assessment 2: Literature review.
2000 words ± 10%
Weighting: 40%
The purpose of this assessment is to facilitate your professional development by encouraging you to research and critique literature. This type of assessment reinforces the use of current literature, research and benchmarks to inform your nursing practice.
This assessment relates to theme 2.
The research question is ‘assess the evidence for managing palliative care in geriatric nursing (mental health). Choose five peer-reviewed journal articles that are current and relevant and create a literature review of those articles.
For example if you work in:
Aged care – assess the evidence for managing palliative care patients in residential aged care
In your review you must include the following:
• Introduction, background and summary of the purpose of your literature review (rationale)
• Research question -framed as a question (Ensure population cohort are identified)
• A synopsis of the methodologies used to obtain your 5 articles
• The common themes that emerged from the critique of these articles
• Body of the literature review – critical analysis of the research and perspectives from the literature including an assessment of the similarities and differences (compare and contrast author’s opinions on the themes being explored)
• Conclusion – evaluation of the conclusions and recommendations within the literature and their relevance to your nursing practice.
Assessment criteria

Literature Review: Palliative Care in Special Patient Populations

Student’s Name

Institutional Affiliations

Literature Review: Palliative Care in Special Patient Populations

The types of palliative care received by patients usually depend on the types of advanced diseases that they are suffering from. A range of settings exists where special patient populations can receive care. As Abu-Odah et al. (2020) point out, despite the presence of a myriad of palliative care settings to care for patients with advanced diseases, several challenges still hinder the provision of quality healthcare to these populations. The authors have identified the lack of clear evidence-based guidelines to direct the delivery of palliative care to patients in residential care as some of these challenges. The special patient population that will be the focus of this assignment is geriatric patients who require psychiatric palliative care.

The purpose of this assignment is to review the research question – assess the evidence for managing palliative care in geriatric nursing (mental health). This will be done in the form of a literature review. Palliative care is described as an approach to care that is applied to patients with advanced diseases or life-threatening illnesses, including their families and caregivers, and that is meant to improve their quality of life (World Health Organization, 2020). In mental health nursing, palliative care is important because it helps to relieve and prevent mental health suffering from the time of diagnosis through disease management period in patients with life-threatening conditions as well as their families and caregivers. Adequate management of palliative care in mental health practice has been shown to improve quality of care, person-centeredness, outcomes, and autonomy for patients with severe persistent psychological issues (Trachsel et al., 2016). Conversely, inadequate management of palliative care in mental health practice has been shown to be associated with poor psychological outcomes in patients with advanced diseases (Aziz & Saeed, 2018). A literature review is described as “a synthetic review and summary of what is known and unknown regarding the topic of a scholarly body of work, including the current work’s place within the existing knowledge (Maggio et al., 2016, p. 297).” It is used to encourage students to access and critique current literature to help resolve issues or problems they may face in their clinical practice (Australian College of Nursing [ACN], 2020, n.p.).

 

Methodology

The author of this assignment has conducted a comprehensive database search to locate articles with evidence that will best answer the research question. The databases that have been searched include CINAHL, PubMed, Medline, CIAP, Google Scholar, and ProQuest. The key terms used in the search include aged care: palliative care; residential aged care; geriatric mental health palliative care; palliative care in older adults; geriatric palliative care nursing; and geriatric palliative care management. The search has been limited to articles published within the past 5 years from 2016 to 2021. A theme that was becoming apparent in the articles is palliative care management in geriatric psychiatric palliative care patients.

A Synopsis of the Methodology

1.      Aziz, V. & Saeed, R. (2018). Palliative care for older people: The psychiatrist’s role. BJPsych Advances, 25(1):1-1. doi:10.1192/bja.2018.33.

This article discusses palliative psychiatric care management in older people who need end-of-life care. The authors of the article have discussed in detail the ethical considerations and the health needs of this group of patients. The specific mental health problems that have been discussed in the article include; dementia, delirium, depression, anxiety, and grief during end-of-life.

1. Lindsey, J. M., Shelton, K. M., Beito, A. H., & Lapid, M. I. (2021). Palliative care: Critical concepts for the geropsychiatrist. Focus (American Psychiatric Publication), 19(3):311-319. doi: 10.1176/appi.focus.20210005. Epub 2021 Jul 9. PMID: 34690598; PMCID: PMC8475929.

The authors of this article have discussed the role of geriatric mental health professionals in enhancing the quality of life of patients who need end-of-life care. They have discussed how geriatric mental health professionals can combine biopsychosociospiritual approaches with hospice and palliative care strategies to effectively add to the quality of end-of-life care in patients with advanced diseases.

1. Santivasi, W. L., Partain, D. K., & Whitford, K. J. (2020). The role of geriatric palliative care in hospitalized older adults. Hospital Practice, 48(sup1):37-47. doi: 10.1080/21548331.2019.1703707. Epub 2019 Dec 22. PMID: 31825689.

This article examined the role of geriatric palliative care professionals in improving the quality of life of hospitalized older adults with life-threatening conditions. The authors have identified the unique needs of patients with advanced diseases and how they can benefit from the services of multidisciplinary teams.

1. Strand, M., Sjöstrand, M., & Lindblad, A. (2020). A palliative care approach in psychiatry: clinical implications. BMC medical ethics, 21(1), 29. https://doi.org/10.1186/s12910-020-00472-8.

The authors of this article have described how the focus of palliative care has changed from the traditional way of managing physical diseases such as cancer to psychiatric disorders such as delirium. They have further identified the gaps in clinical practice guidelines and how they are hindering palliative psychiatric care.

1. Trachsel, M., Irwin, S. A., Biller-Andorno, N., & Hoff, P. & Riese, F. (2016). Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks. BMC Psychiatr,y 16, 260. https://doi.org/10.1186/s12888-016-0970-y

In this article, the authors have shared information regarding the need for mental health professionals to collaborate with other medical doctors to ensure effective palliative care for patients with life-threatening mental disorders. They have emphasized the need to incorporate psychiatric care into the palliative care interventions for patients with terminal medical conditions.

Critical Examination of the Literature

 

Presentation of the Common Themes

The reviewed articles have three themes in common. The themes include; the need to improve clinical practice guidelines to enhance palliative psychiatric care for older adults with life-threatening diseases (Aziz & Saeed, 2018; Strand et al., 2020); the palliative mental health professional plays a crucial role in enhancing palliative care effectiveness in patients with advanced diseases (Lindsey et al., 2021; Santivasi et al., 2020); and multidisciplinary teams can help to improve the quality of life for older adults who need palliative care (Trachsel et al., 2016; Lindsey et al., 2021; Santivasi et al., 2020). All five articles are looking at the same issue that is palliative psychiatric care management in older adults with advanced terminal mental and medical conditions. However, there are slight variations in the study objectives and the concepts that have been explored by the authors.

Agreements and Disagreements Within the Articles Including Conclusions and Recommendations

Theme 1: The Need to Improve Clinical Practice Guidelines

Two articles support the theme related to the need to improve clinical practice guidelines to enhance palliative psychiatric care for older adults with life-threatening diseases. According to Aziz and Saeed (2018), palliative psychiatric care of older people who are suffering from terminal mental health problems should follow evidence-based clinical practice guidelines. However, sufficient evidence is lacking to help address this problem. Similarly, Strand et al. (2020) have pointed out the need to shift the focus of palliative care from the traditional form of caring for patients with physical illnesses such as cancer to new clinical practice guidelines that detail how to provide end-of-life care to patients with life-threatening psychiatric disorders such as dementia and delirium. Aziz and Saeed (2018) and Strand et al. (2020) have applied a qualitative approach to data collection. The two articles have documented almost similar findings indicating that there are inadequate clinical practice guidelines to direct palliative care for patients with life-threatening mental disorders. They have concluded that patients with terminal mental disorders need palliative care just like patients with other terminal medical conditions. A common recommendation from the two articles is that aged residential facilities should have evidence-based practice guidelines to direct palliative psychiatric care for older adults with terminal mental conditions.

Theme 2: The Palliative Mental Health Professional Plays a Crucial Role in Palliative Care Management

Patients with life-threatening conditions also suffer from psychological issues that can best be addressed by qualified mental health professionals. A common theme that has emerged in two of the reviewed articles is the crucial role that a palliative mental health professional plays in the lives of older adults with terminal illnesses (Lindsey et al., 2021; Santivasi et al., 2020). According to Lindsey et al. (2021), palliative mental health professionals make a significant contribution to improving the quality of end-of-life care for older adults with terminal medical conditions. Similarly, Santivasi et al. (2020) has reported that terminally ill older adults need the services of a palliative mental health professional to be able to attain an improved quality of life. The authors of the two articles have almost similar conclusions and recommendations. They have concluded the palliative psychiatric care improves the psychological health and well-being of terminally ill patients as well as their families and caregivers. They have recommended that geriatric palliative care should integrate mental health care to enhance the achievement of improved quality of life.

Theme 3: Multidisciplinary Involvement in Palliative Care Management

Caring for patients during end-of-life requires multidisciplinary collaboration. This theme has clearly come out from the reviewed literature. Trachsel et al. (2016) conducted a theoretical investigation to examine the effectiveness of palliative psychiatry in improving the psychological well-being of geriatric patients in their end of life. The researchers discovered that palliative mental health professionals are important members of the multidisciplinary team involved in the care of terminally ill patients. The important role that is played by a palliative mental health professional in the life of a patient with life-threatening illnesses is further supported by Lindsey et al. (2021) and Santivasi et al. (2020). Trachsel et al. (2016) have concluded that the first step to effective palliative care planning is to acknowledge the specific health needs of a patient. They have recommended that care planning for patients with life-threatening illnesses should include a team of healthcare professionals including as well as mental health assessment and treatment by a qualified palliative mental health professional.

Relevance of the Information to Nursing

The information presented in the reviewed articles is relevant to nursing. It gives evidence that palliative mental health professionals can use to improve the psychological well-being and improved quality of life for patients with life-threatening conditions and their families. Nurses play a crucial role in the lives of patients with different types of health problems including those who need end-of-life care (Milligan, 2018; Prince-Paul & Daly, 2019). To be able to provide quality and safe care to their patients, nurses must implement evidence-based interventions that are supported by research and palliative care is no exception. Palliative care nurses need the information contained in the reviewed articles to improve mental clinical practice and palliative care management for geriatrics who need end-of-life care.

Conclusion

The purpose of this assignment was to review the research question – assess the evidence for managing palliative care in geriatric nursing (mental health). This has been done in the form of a literature review. The literature review has answered the research question. Precisely, the evidence contained in the reviewed literature has supported the involvement of a palliative mental health professional in managing palliative care geriatric patients in mental health practice (Trachsel et al., 2016; Lindsey et al., 2021; Santivasi et al., 2020). Caring for patients during end-of-life requires multidisciplinary collaboration (Jansson et al., 2017). Inadequate management of palliative care has been shown to be contributed by the lack of clear evidence-based clinical practice guidelines for use with patients who have terminal mental health conditions such as delirium and dementia (Aziz & Saeed, 2018; Strand et al., 2020). Advance care planning will help to solve this problem (Detering et al., 2020; Advance Care Planning Australia, 2021). Specifically, advance care planning will ensure that a qualified palliative mental health professional is included in the care plan for a geriatric patient with a life-threatening condition.

References

Abu-Odah, H., Molassiotis, A. & Liu, J. (2020). Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews. BMC Palliative Care, 19, 55. https://doi.org/10.1186/s12904-020-00558-5

Advance Care Planning Australia. (2021). Advance care planning. Austin Health. https://www.advancecareplanning.org.au/individuals/what-is-advance-care-planning.

Australian College of Nursing. (2020). https://www.acn.edu.au/s

Aziz, V. & Saeed, R. (2018). Palliative care for older people: The psychiatrist’s role. BJPsych Advances, 25(1):1-1. doi:10.1192/bja.2018.33.

Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010). The impact of advance care planning on end-of-life care in elderly patients: randomised controlled trial. British Medical Journal (Clinical research ed.), 340, c1345. https://doi.org/10.1136/bmj.c1345.

Jansson, M., Dixon, K., & Hatcher, D. (2017). The palliative care experiences of adults living in regional and remote areas of Australia: A literature review. Contemporary Nurse, 53(1), 94–104. https://doi.org/10.1080/10376178.2016.1268063.

Lindsey, J. M., Shelton, K. M., Beito, A. H., & Lapid, M. I. (2021). Palliative care: Critical concepts for the geropsychiatrist. Focus (American Psychiatric Publication), 19(3):311-319. doi: 10.1176/appi.focus.20210005. Epub 2021 Jul 9. PMID: 34690598; PMCID: PMC8475929.

Maggio, L. A., Sewell, J. L., & Artino, A. R., Jr. (2016). The literature review: A foundation for high-quality medical education research. Journal of Graduate Medical Education, 8(3), 297–303. https://doi.org/10.4300/JGME-D-16-00175.1

Milligan, S. P. (2018). Chapter 1: Who is the palliative care patient. In C. Walshe, N. Preston, B. Johnston (Eds.), Palliative care nursing: Principles and evidence for practice (3rd ed., pp.5-21). Oxford University Press.

Prince-Paul, M., & Daly, B. J. (2019). Chapter 70: Ethical considerations in palliative care. In B. R. Ferrell, & J. A. Paice (Eds.), Oxford Handbook of palliative nursing (5th ed.). Oxford University Press.

Santivasi, W. L., Partain, D. K., & Whitford, K. J. (2020). The role of geriatric palliative care in hospitalized older adults. Hospital Practice, 48(sup1):37-47. doi: 10.1080/21548331.2019.1703707. Epub 2019 Dec 22. PMID: 31825689.

Strand, M., Sjöstrand, M., & Lindblad, A. (2020). A palliative care approach in psychiatry: clinical implications. BMC Medical Ethics, 21(1), 29. https://doi.org/10.1186/s12910-020-00472-8.

Trachsel, M., Irwin, S. A., Biller-Andorno, N., & Hoff, P. & Riese, F. (2016). Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks. BMC Psychiatry 16, 260. https://doi.org/10.1186/s12888-016-0970-y

World Health Organization. (2020). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care